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<html>
<body>
<link rel="stylesheet" type="text/css" href="css/PrepskillsFont.css" />

<form action=https://prepskills.com/cgi-bin/ntformmail.pl method=post>
<input type=hidden name="recipient"
	value="info@prepskills.com, jseverino@prepskills.com, education@prepskills.com">
<input type=hidden name="redirect"
	value="https://prepskills.com/sent.html"> <input type=hidden
	name="return_link_url" value="https://prepskills.com/sent.html">
<input type=hidden name="subject" value="SAT Webinar Registration">
<input type=hidden name="required"
	value="email, StudentFN, StudentLN, Address, City, PostalCode, TypeofCard, NameonCard, CardNumber, CCExpiryMM, CCExpiryYYYY">

<table bgcolor="034016" border=0 cellpadding="0" cellspacing="0"
	align="center" width="960">
	<tr>

		<td>
		<table bgcolor="ffffff" class="askprepform" border=0 cellpadding="0"
			cellspacing="0" align="center" width="940">
 <tr>
    <td colspan="4" class="style5"><div align="center">PREPSKILLS<sup>&reg;</sup> PSAT PREPARATION COURSE REGISTRATION</div></td>
    </tr>
  <tr>

    <td bgcolor="#D9D9D9"><span class="style21">Select a Location & Date:</span></td>
    <td colspan="3" bgcolor="#EAEAEA">
      <span class="style21">
      <select name="PSATCourseDate" id="PSATCourseDate">
	    <option value="Toronto PSAT: Wednesdays - August 3rd, 10th, 17th, 24th at York University">Toronto PSAT: Wednesdays - August 3rd, 10th, 17th, 24th at York University</option>
		<option value="Ottawa PSAT: Wednesdays - August 3rd, 10th, 17th, 24th at St. Paul's University">Ottawa PSAT: Wednesdays - August 3rd, 10th, 17th, 24th at St. Paul's University</option>
        <option value="Toronto PSAT: Sundays – Sept 18th, 25th, Oct 1st, Oct 2nd at York University">Toronto PSAT: Sundays – Sept 18th, 25th, Oct 1st, Oct 2nd at York University</option>

		<option value="Ottawa PSAT: Sundays – Sept 18th, 25th, Oct 1st, Oct 2nd at St. Paul's University">Ottawa PSAT: Sundays – Sept 18th, 25th, Oct 1st, Oct 2nd at St. Paul's University</option>
		
		
      </select>
      </span> </td>
    </tr>
  <tr>
    <td bgcolor="f4f7e7"><span class="style21">      Email Address:<br>
        <span class="style18">REQUIRED</span></span></td>

    <td colspan="3" bgcolor="f4f7e7"><span class="style21">
      <input type="text" name="email" size="30" border="0">       
      <br>
      (Important: Course communication, login ID, and other relevant parent/student information will be sent to this email address. Please ensure that you check your email regularly)</span></td>
    </tr>
  <tr>
    <td colspan="4" bgcolor="#EAEAEA"><span class="style21">How did you learn about PREPSKILLS<sup>&reg;</sup>?</span></td>
    </tr>

  <tr>
    <td bgcolor="f4f7e7" width=243><span class="style21">Please Select:</span></td>
    <td bgcolor="f4f7e7" width=242><span class="style21"><FONT face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">
      <select name="Reference">
        <option value="Other">Other</option>
        <option value="School/Teacher">School/Teacher</option>
        <option value="Internet search">Internet search</option>

        <option value="Friend">Friend</option>
        <option value="PREPSKILLS(tm) Seminar">PREPSKILLS Seminar</option>
        <option value="Education Fair">Education Fair</option>
        <option value="Brochure/Flyer">Brochure/Flyer</option>
        <option value="PREPSKILLS(tm) Sign">PREPSKILLS Sign</option>
        <option value="Education Guide">Education Guide</option>

      </select>
    </FONT></span></td>
    <td bgcolor="f4f7e7" width=242><span class="style21">Specify:</span></td>
    <td bgcolor="f4f7e7" width=242><span class="style21"><FONT face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">
      <input name="OtherReference" type="text" size=30>
    </FONT></span></td>
  </tr>
  <tr>

    <td colspan="4" bgcolor="#94ce18"  class="style5"><div align="center">STUDENT INFORMATION</div></td>
    </tr>
  <tr>
    <td bgcolor="#EAEAEA"><div align="center" class="style21">Student First Name</div></td>
    <td bgcolor="#EAEAEA"><div align="center" class="style21">Student Last Name</div></td>
    <td bgcolor="#EAEAEA"><div align="center" class="style21">Gender</div></td>
    <td bgcolor="#EAEAEA"><div align="center" class="style21">Current Grade</div></td>

  </tr>
  <tr>
    <td bgcolor="f4f7e7"><div align="center" class="style21">
      <input type="text" name="StudentFN" size="30" border="0">
    </div></td>
    <td bgcolor="f4f7e7"><div align="center" class="style21">
      <input type="text" name="StudentLN" size="30" border="0">
    </div></td>
    <td bgcolor="f4f7e7" align=center>

      <span class="style21">
      <label>

          <input type="radio" name="Gender" id="Male" value="Male">
      </label>
      Male
      <label> &nbsp;&nbsp;&nbsp;
        <input type="radio" name="Gender" id="Female" value="Female">
      </label>

Female </span></td>
    <td bgcolor="f4f7e7"><div align="center" class="style21"><FONT face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">
      <select name="ChildCurrentGrade">
      <option selected="selected" value=""></option>
        <option value="9">9</option>
        <option value="10">10</option>
        <option value="11">11</option>

        <option value="12">12</option>
      </select>
    </FONT></div></td>
  </tr>
  <tr>
    <td bgcolor="#EAEAEA"><div align="center" class="style21">Date of Birth</div></td>
    <td bgcolor="#EAEAEA"><div align="center" class="style21">Age</div></td>

    <td bgcolor="#EAEAEA"><div align="center" class="style21">School Presently Attended</div></td>
    <td bgcolor="#EAEAEA"><div align="center" class="style21">When do you anticipate enrolment?&nbsp;</div></td>
  </tr>
  <tr>
    <td bgcolor="f4f7e7"><div align="center" class="style21">
      <div align="center">
        <select name="DOBDD" id="DOBDD">
          <option selected="selected" value=""></option>

          <option value="01">01</option>
          <option value="02">02</option>
          <option value="03">03</option>
          <option value="4">04</option>
          <option value="5">05</option>
          <option value="6">06</option>

          <option value="7">07</option>
          <option value="8">08</option>
          <option value="9">09</option>
          <option value="10">10</option>
          <option value="11">11</option>
          <option value="12">12</option>

          <option value="13">13</option>
          <option value="14">14</option>
          <option value="15">15</option>
          <option value="16">16</option>
          <option value="17">17</option>
          <option value="18">18</option>

          <option value="19">19</option>
          <option value="20">20</option>
          <option value="21">21</option>
          <option value="22">22</option>
          <option value="23">23</option>
          <option value="24">24</option>

          <option value="25">25</option>
          <option value="26">26</option>
          <option value="27">27</option>
          <option value="28">28</option>
          <option value="29">29</option>
          <option value="30">30</option>

          <option value="31">31</option>
        </select>
        <select name="DOBMM" id="DOBMM">
          <option selected="selected" value=""></option>
          <option value="1">Jan</option>
          <option value="2">Feb</option>
          <option value="3">Mar</option>

          <option value="4">Apr</option>
          <option value="5">May</option>
          <option value="6">Jun</option>
          <option value="7">Jul</option>
          <option value="8">Aug</option>
          <option value="9">Sep</option>

          <option value="10">Oct</option>
          <option value="11">Nov</option>
          <option value="12">Dec</option>
        </select>
        <select name="DOBYYYY" id="DOBYYYY">
          <option selected="selected" value=""></option>
          <option value="1980">1980</option>

          <option value="1981">1981</option>
          <option value="1982">1982</option>
          <option value="1983">1983</option>
          <option value="1984">1984</option>
          <option value="1985">1985</option>
          <option value="1986">1986</option>

          <option value="1987">1987</option>
          <option value="1988">1988</option>
          <option value="1989">1989</option>
          <option value="1990">1990</option>
          <option value="1991">1991</option>
          <option value="1992">1992</option>

          <option value="1993">1993</option>
          <option value="1994">1994</option>
          <option value="1995">1995</option>
          <option value="1996">1996</option>
          <option value="1997">1997</option>
          <option value="1998">1998</option>

          <option value="1999">1999</option>
          <option value="2000">2000</option>
          <option value="2001">2001</option>
          <option value="2002">2002</option>
          <option value="2003">2003</option>
          <option value="2004">2004</option>

        </select>
        </div>
    </div></td>
    <td bgcolor="f4f7e7"><div align="center" class="style21"><FONT face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">
      <select name="Age" id="Age">
      <option selected="selected" value=""></option>
        <option value="13">13</option>
        <option value="14">14</option>

        <option value="15">15</option>
        <option value="16">16</option>
        <option value="17">17</option>
        <option value="18">18</option>
        <option value="19">19</option>
        <option value="20">20</option>

        <option value="21">21</option>
        <option value="22">22</option>
        <option value="23">23</option>
        <option value="24">24</option>
        <option value="25">25</option>
        <option value="26">26</option>

        <option value="27">27</option>
        <option value="28">28</option>
        <option value="29">29</option>
        <option value="30">30</option>
      </select>
    </div></td>
    <td bgcolor="f4f7e7"><div align="center" class="style21">

      <div align="center"><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">
        <input name="CurrentSchool" type="text" size=30>
        </font></div>
    </div></td>
    <td bgcolor="f4f7e7"><div align="center" class="style21">
      <div align="center">
        <select name="EnrolementDateMM" id="EnrolementDateMM">
          <option selected="selected" value=""></option>
          <option value="1">Jan</option>

          <option value="2">Feb</option>
          <option value="3">Mar</option>
          <option value="4">Apr</option>
          <option value="5">May</option>
          <option value="6">Jun</option>
          <option value="7">Jul</option>

          <option value="8">Aug</option>
          <option value="9">Sep</option>
          <option value="10">Oct</option>
          <option value="11">Nov</option>
          <option value="12">Dec</option>
        </select>

        <select name="EnrolementDateYYYY" id="EnrolementDateYYYY">
          <option selected="selected" value=""></option>
          <option value="2009">2009</option>
          <option value="2010">2010</option>
          <option value="2011">2011</option>
          <option value="2012">2012</option>
          <option value="2013">2013</option>

          <option value="2014">2014</option>
          <option value="2015">2015</option>
          <option value="2016">2016</option>
          <option value="2017">2017</option>
          <option value="2018">2018</option>
          <option value="2019">2019</option>

          <option value="2020">2020</option>
        </select>
      </div>
    </div></td>
  </tr>
  <tr>
    <td colspan="2" bgcolor="#EAEAEA"><div align="center"><span class="style24">Has the student written the SAT or ACT?</span></div></td>
    <td colspan="2" bgcolor="#EAEAEA"><div align="center"><span class="style24">If not, has the student written the PREPSKILLS Diagnostic or Simulation SAT?</span></div></td>

    </tr>
  <tr>
    <td colspan="2" bgcolor="f4f7e7">
        <div align="center"><span class="style24">
        </span></div>
        <span class="style24"><label>
          <div align="center">
            <select name="WrittenSATorACT" id="WrittenSATorACT">
            <option selected="selected" value=""></option>

              <option value="Yes">Yes</option>
              <option value="No">No</option>
            </select>
          </div>
        </label>
        </span> </td>
    <td colspan="2" bgcolor="f4f7e7"><div align="center"><span class="style24">

      <select name="WrittenDiagnostic" id="WrittenDiagnostic">
      <option selected="selected" value=""></option>
        <option value="Yes">Yes</option>
        <option value="No">No</option>
      </select>
    </span></div></td>
    </tr>
  <tr>

    <td colspan="4" bgcolor="#EAEAEA"><span class="style24">If you answered &quot;no&quot; to both questions, when does the student plan to write the SAT or ACT?
        <select name="WriteSATDateMM2" id="WriteSATDateMM">
          <option selected="selected" value=""></option>
          <option value="1">Jan</option>
          <option value="2">Feb</option>
          <option value="3">Mar</option>

          <option value="4">Apr</option>
          <option value="5">May</option>
          <option value="6">Jun</option>
          <option value="7">Jul</option>
          <option value="8">Aug</option>
          <option value="9">Sep</option>

          <option value="10">Oct</option>
          <option value="11">Nov</option>
          <option value="12">Dec</option>
        </select>
        <select name="WriteSATDateYYYY2" id="WriteSATDateYYYY2">
          <option selected="selected" value=""></option>
          <option value="2009">2009</option>

          <option value="2010">2010</option>
          <option value="2009">2011</option>
          <option value="2010">2012</option>
          <option value="2009">2013</option>
          <option value="2010">2014</option>
          <option value="2009">2015</option>

          <option value="2010">2016</option>
          <option value="2009">2017</option>
          <option value="2010">2018</option>
          <option value="2009">2019</option>
          <option value="2010">2020</option>
        </select>

    </span></td>
  </tr>
  <tr>
    <td colspan="4" bgcolor="f4f7e7"><span class="style24">what are the student's top 3 choices for American colleges? </span>
      <label>
      <input name="Top3Choices" type="text" id="Top3Choices" size="90">
      </label></td>
  </tr>

  
  <tr>
    <td colspan="4" bgcolor="#94ce18"  class="style5"><div align="center">PARENT INFORMATION</div></td>
    </tr>
  <tr>
    <td bgcolor="#EAEAEA"><div align="center"><span class="style21">(Mother) First Name</span></div></td>
    <td bgcolor="#EAEAEA"><div align="center"><span class="style21">Last Name</span></div></td>
    <td bgcolor="#EAEAEA"><div align="center"><span class="style21">Home Phone Number</span></div></td>

    <td bgcolor="#EAEAEA"><div align="center"><span class="style21">Email</span></div></td>
  </tr>
  <tr>
    <td bgcolor="f4f7e7"><div align="center"><span class="style21"><FONT face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">
      <input name="MotherFN" type="text" id="MotherFN" size="30" />
    </FONT></span></div></td>
    <td bgcolor="f4f7e7"><div align="center"><span class="style21"><FONT face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">
      <input name="MotherLN" type="text" id="MotherLN" size="30" />

    </FONT></span></div></td>
    <td bgcolor="f4f7e7"><div align="center"><span class="style21"><FONT face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">
      <input name="MotherHomePh" type="text" value="(xxx) xxx - xxxx" size="30" maxlength="20" id="MotherHomePh" />
    </FONT></span></div></td>
    <td bgcolor="f4f7e7"><div align="center"><span class="style21"><FONT face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">
      <input name="MotherEmail" type="text" value="name@domain.com" id="MotherEmail" size="30" />
    </FONT></span></div></td>
  </tr>
  <tr>

    <td colspan="2" bgcolor="#EAEAEA"><div align="center"><span class="style21">Occupation</span></div></td>
    <td bgcolor="#EAEAEA"><div align="center"><span class="style21">Business Phone Number</span></div></td>
    <td bgcolor="#EAEAEA"><div align="center"><span class="style21">Cell Phone Number</span></div></td>
  </tr>
  <tr>
    <td colspan="2" bgcolor="f4f7e7"><div align="center"><span class="style21"><FONT face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">
      <input name="MotherOccup" type="text" id="MotherOccup" size="60">

    </FONT></span></div></td>
    <td bgcolor="f4f7e7"><div align="center"><span class="style21"><FONT face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">
      <input name="MotherBusinessPh" type="text" value="(xxx) xxx - xxxx" size="30" maxlength="20" id="MotherBusinessPh" />
    </FONT></span></div></td>
    <td bgcolor="f4f7e7"><div align="center"><span class="style21"><FONT face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">
      <input name="MotherCell" type="text" value="(xxx) xxx - xxxx" size="30" maxlength="20" id="MotherCell" />
    </FONT></span></div></td>
  </tr>
  <tr>

    <td bgcolor="#EAEAEA"><div align="center"><span class="style21">(Father) First Name</span></div></td>
    <td bgcolor="#EAEAEA"><div align="center"><span class="style21">Last Name</span></div></td>
    <td bgcolor="#EAEAEA"><div align="center"><span class="style21">Home Phone Number</span></div></td>
    <td bgcolor="#EAEAEA"><div align="center"><span class="style21">Email</span></div></td>
  </tr>
  <tr>
    <td bgcolor="f4f7e7"><div align="center"><span class="style21"><FONT face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">

      <input name="FatherFN" type="text" id="FatherFN" size="30" />
    </FONT></span></div></td>
    <td bgcolor="f4f7e7"><div align="center"><span class="style21"><FONT face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">
      <input name="FatherLN" type="text" id="FatherLN" size="30" />
    </FONT></span></div></td>
    <td bgcolor="f4f7e7"><div align="center"><span class="style21"><FONT face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">
      <input name="FatherHomePh" type="text" value="(xxx) xxx - xxxx" size="30" maxlength="20" id="FatherHomePh" />
    </FONT></span></div></td>
    <td bgcolor="f4f7e7"><div align="center"><span class="style21"><FONT face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">

      <input name="FatherEmail" type="text" value="name@domain.com" id="FatherEmail" size="30" />
    </FONT></span></div></td>
  </tr>
  <tr>
    <td colspan="2" bgcolor="#EAEAEA"><div align="center"><span class="style21">Occupation</span></div></td>
    <td bgcolor="#EAEAEA"><div align="center"><span class="style21">Business Phone Number</span></div></td>
    <td bgcolor="#EAEAEA"><div align="center"><span class="style21">Cell Phone Number</span></div></td>

  </tr>
  <tr>
    <td colspan="2" bgcolor="f4f7e7"><div align="center"><span class="style21"><FONT face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">
      <input name="FatherOccup" type="text" id="FatherOccup" size="60">
    </FONT></span></div></td>
    <td bgcolor="f4f7e7"><div align="center"><span class="style21"><FONT face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">
      <input name="FatherBusinessPh" type="text" value="(xxx) xxx - xxxx" size="30" maxlength="25" id="FatherBusinessPh" />
    </FONT></span></div></td>
    <td bgcolor="f4f7e7"><div align="center"><span class="style21"><FONT face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">

      <input name="FatherCell" type="text" value="(xxx) xxx - xxxx" size="30" maxlength="25" id="FatherCell" />
    </FONT></span></div></td>
  </tr>
  <tr>
    <td colspan="4" bgcolor="#94ce18"  class="style5"><div align="center">MAILING ADDRESS</div></td>
    </tr>
  <tr>
    <td bgcolor="#EAEAEA"><div align="center" class="style21">Address</div></td>

    <td bgcolor="#EAEAEA"><div align="center" class="style21">City</div></td>
    <td bgcolor="#EAEAEA"><div align="center" class="style21">Province</div></td>
    <td bgcolor="#EAEAEA"><div align="center" class="style21">Postal Code</div></td>
  </tr>
  <tr>
    <td bgcolor="f4f7e7"><div align="center" class="style21"><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">
      <input name="Address" type="text" size="30">

    </font></div></td>
    <td bgcolor="f4f7e7"><div align="center" class="style21"><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">
      <input name="City" type="text" id="City" size="30">
    </font></div></td>
    <td bgcolor="f4f7e7"><div align="center" class="style21">
      <select name="Province">
        <option value="Ontario">Ontario</option>
        <option value="Quebec">Quebec</option>

        <option value="Newfoundland">Newfoundland</option>
        <option value="New Brunswick">New Brunswick</option>
        <option value="Nova Scotia">Nova Scotia</option>
        <option value="Prince Edward Island">Prince Edward Island</option>
        <option value="Manitoba">Manitoba</option>
        <option value="Saskatchewan">Saskatchewan</option>

        <option value="Alberta">Alberta</option>
        <option value="British Columbia">British Columbia</option>
        <option value="Northwest Territories">Northwest Territories</option>
        <option value="Yukon">Yukon</option>
      </select>
    </div></td>
    <td bgcolor="f4f7e7"><div align="center" class="style21"><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">

      <input name="PostalCode" type="text" id="PostalCode" size="8">
    </font></div></td>
  </tr>
  <tr>
    <td colspan="4" bgcolor="#94ce18"  class="style5"><div align="center">ADDITIONAL INFORMATION</div></td>
    </tr>
  <tr>
    <td colspan="4" bgcolor="#EAEAEA"><div align="center" class="style21">Comments</div></td>

    </tr>
  <tr>
    <td colspan="4" bgcolor="f4f7e7">
      <div align="center">
        <textarea name="Comments" rows="3" cols="110"></textarea>
      </div></td>
    </tr>
  <tr>

    <td colspan="4" bgcolor="#94ce18"  class="style5"><div align="center">FEES & PAYMENT INFORMATION</div></td>
    </tr>
  <tr>
    <td colspan="4" bgcolor="#EAEAEA"><p class="style21"><strong>FEES: </strong><br>
       
        <strong>$795 + HST <span class="style18">(cheque, money order, or VISA/MASTERCARD* - call (416) 200-7728 to process your visa/mastercard registration if desired)</span></strong><br>
     
    </span></td>

    </tr>
  <tr>
    <td valign="top" bgcolor="#f4f7e7" class="style21"><br>
      <strong>Cheque / Money Order</strong></td>
    <td colspan="3" bgcolor="#f4f7e7" class="style21"><p><span class="style21">Titled To: </span><strong><span class="style21">PREPSKILLS INC.</span></strong></p>
      <p><span class="style21">Mailing Address: 250 Merton Street, Suite 404, 
Toronto, Ontario, M4S 1B1</span></p>
      <p><span class="style21"><span class="style18"><strong>FULL PAYMENT MUST BE RECEIVED AT THE TIME OF REGISTRATION</strong></span></span></p></td>

    </tr>
  <tr>
    <td colspan="4" bgcolor="#EAEAEA" class="style21"><strong>Credit Card Payment</strong></td>
    </tr>
  <tr>
    <td bgcolor="#f4f7e7" class="style21"><div align="center">Type of Card</div></td>
    <td bgcolor="#f4f7e7" class="style21"><div align="center">Name on Card</div></td>

    <td bgcolor="#f4f7e7" class="style21"><div align="center">Card Number</div></td>
    <td bgcolor="#f4f7e7" class="style21"><div align="center">Expiry Date</div></td>
  </tr>
  <tr>
    <td bgcolor="#EAEAEA" class="style21"><div align="center">
      <select name="TypeofCard">
        <option selected="selected" value=""></option>
        <option value="Visa">Visa</option>

        <option value="Mastercard">Mastercard</option>
      </select>
    </div></td>
    <td bgcolor="#EAEAEA" class="style21"><div align="center"><FONT face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">
      <input name="NameonCard" type="text" id="NameonCard" size="30" />
    </FONT></div></td>
    <td bgcolor="#EAEAEA" class="style21"><div align="center"><FONT face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">
      <input name="CardNumber" type="text" id="CardNumber" size="30" />

    </FONT></div></td>
    <td bgcolor="#EAEAEA" class="style21"><div align="center">
      <select name="CCExpiryMM" id="CCExpiryMM">
        <option selected="selected" value=""></option>
        <option value="01">Jan</option>
        <option value="02">Feb</option>
        <option value="03">Mar</option>

        <option value="04">Apr</option>
        <option value="05">May</option>
        <option value="06">Jun</option>
        <option value="07">Jul</option>
        <option value="08">Aug</option>
        <option value="09">Sep</option>

        <option value="10">Oct</option>
        <option value="11">Nov</option>
        <option value="12">Dec</option>
      </select>
      <select name="CCExpiryYYYY" id="CCExpiryYYYY">
        <option selected="selected" value=""></option>
        <option value="2009">2009</option>

        <option value="2010">2010</option>
        <option value="2011">2011</option>
        <option value="2012">2012</option>
        <option value="2013">2013</option>
        <option value="2014">2014</option>
        <option value="2015">2015</option>

        <option value="2016">2016</option>
        <option value="2017">2017</option>
        <option value="2018">2018</option>
        <option value="2019">2019</option>
        <option value="2020">2020</option>
      </select>

    </div></td>
  </tr>
  <tr>
    <td colspan="4" bgcolor="#f4f7e7"><p class="style21">For more information please phone <span class="style18"><strong>(416) 200-7728</strong></span></p>
      <p class="style21"><strong>I assume full responsibility for payment</strong>. I have read and acknowledged the <a href="http://www.prepskills.com/main/fees-policies" target="_blank">PREPSKILLS INC. policy including prepayment, no refunds or make up lessons</a> as outlined.</p>

      <p class="style21">I agree to the terms and conditions set forth by PREPSKILLS Inc.</p>
      <p class="style21">I recognize and accept that no reputable organization can make any guarantee as the development of skills or the results of future tests.</p>
      <p class="style21">I hereby release PREPSKILLS INC. or staff and the location from all claims, demands, losses, actions suits or proceeding rising out of the participation of the applicant named in any facility or at any location where the program/tutoring is being held.</p>
      <p class="style21">I hereby release PREPSKILLS INC. or staff and the location from all claims, demands, losses, actions suits or proceeding rising out of the participation of the applicant named in any facility or at any location where the program/tutoring is being held.</p>
      <p class="style21"><strong><u>Your invoice will be issued to you via email upon submitting this online registration.</u></strong></p></td>
    </tr>

  <tr>
    <td colspan="4" bgcolor="#94ce18"  class="style5"><div align="center"><input type="submit" value="Submit"></div></td>
    </tr>

		</table>
	</td>
	</tr>
</table>
</form>

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